Provider Demographics
NPI:1720146947
Name:FRITZ, JILL ELIZABETH (MSN, ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ELIZABETH
Last Name:FRITZ
Suffix:
Gender:F
Credentials:MSN, ANP-BC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ELIZABETH
Other - Last Name:AUTHMUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, ANP-BC
Mailing Address - Street 1:545 BRANSON LANDING BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-4500
Mailing Address - Country:US
Mailing Address - Phone:417-335-7490
Mailing Address - Fax:417-335-7588
Practice Address - Street 1:3800 S NATIONAL AVE STE 510
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5284
Practice Address - Country:US
Practice Address - Phone:417-875-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2003005233363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420006562Medicaid
MO122640015Medicare PIN